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Applying for enrollment in UPMC for Life is easy

Follow the steps below to apply for enrollment in a UPMC for Life plan.

  1. Choose the UPMC for Life plan in which you would like to apply for enrollment.
    Click here
    to compare plan options and benefits.

  2. Apply for enrollment. We offer three different ways to apply:
    • Call us toll-free at 1-866-400-5077 to apply for enrollment over the phone. Representatives are available seven days a week from 8 a.m. to 8 p.m.* TTY users should call 1-800-361-2629.
    • Apply online using our secure enrollment website.
    • Print and mail your enrollment application. Click on the enrollment application for your area to download and print.

      Enrollment Application Form

      Enrollment Application Form

      Enrollment Application Form

      Enrollment Application Form

      Enrollment Application Form

      Enrollment Application Form

      Enrollment Application Form

      After you have completed the enrollment application form, mail it to us at:
      UPMC for Life
      PO Box 2967
      Pittsburgh, PA 15230-9474

  3. We will contact you once your enrollment application has been processed.

You can also enroll online via the Medicare website at Medicare.gov.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium, and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Out-of-network/non-contracted providers are under no obligation to treat UPMC for Life members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Other physicians/providers are available in the UPMC for Life network.

The UPMC for Life Medicare Advantage HMO and PPO plans are available to persons entitled to Medicare Part A and enrolled in Part B. You must continue to pay your Medicare Part B premium, reside in the service area, and not have end-stage renal disease (ESRD).

This information is available for free in other languages. Please call our customer service number at 1-877-539-3080 (TTY: 1-800-361-2629). We are available October 1 through February 14, seven days a week from 8 a.m. to 8 p.m. From February 15 through September 30, we are available Monday through Friday from 8 a.m. to 8 p.m. and Saturday from 8 a.m. to 3 p.m.

UPMC for Life has a contract with Medicare to provide HMO and PPO plans. Enrollment in UPMC for Life depends on contract renewal. UPMC for Life is a product of and operated by UPMC Health Plan Inc., UPMC Health Network Inc., and UPMC Health Benefits Inc.

The Silver&Fit program is a product of American Specialty Health Fitness, Inc., (ASH Fitness), a subsidiary of American Specialty Health Incorporated (ASH). All programs and services are not available in all areas. Silver&Fit® is a federally registered trademark of ASH and used with permission herein.

*Our hours of operation change twice a year.

You can call us:

October 1 through February 14:
seven days a week from 8 a.m. to 8 p.m.

February 15 through September 30:
Monday through Friday: 8 a.m. to 8 p.m.
Saturday: 8 a.m. to 3 p.m.

Y0069_18_1122 Approved

Last Updated: 10/01/2017
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